HomeMy Public PortalAbout9433 LEMON AVE_Mechanical__ 76A364—CE81 B-1-68 4 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FEBUILDIBUILDING AND SAFETY DIVISION 3 �. �y.-.�.�-JOHN A. LAMBIE. COUNTY ENGINEER•COLEMAN W. JENKINS, SUPERINTENDENT DF BUILDINGY
NEAREST v
FOR APPLICANT TO FILL IN .
(Print or type only)
OWNER "
NO. TYPEIOFAPPLIANCE OR EQUIPMENT FEE
MAIL
ADDRESS
ABSORPTION SYSTEM, BTU CITY 4 TEL. NO..
AIR HANDLING UNIT, CFM CONTRACTOR
BOILER, HORSEPOWER ADDRESS
COMPRESSOR, HORSEPOWER 4400 CITY TEL. NO.
STATE LI C.
VENTILATION SYSTEM LICENSE NO. CLASS
DISTRICT NO. GROUP HONE I PROCESSED BY
EVAPORATIVE COOLER J^O f`)//`
FURNACE: FAU GRAVITY c�
FLOOR—BTUINSPECTION RECORD v
HEATER: SUSPENDED UNIT �
WALL' [� O
H
U
' W
LL
C/7
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NEW—ADDITION PERMIT $ 3 00
ALTER—REPAIR— TOTAL FEE $ Q�
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
HEATING, VENTILATING, AIR CONDITIONING
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9; DIVISION 3, OF THE BUSINESS AND PROFESSIONAL
CODE OF THE STATE LIFORNIA APPROVALS DATE PECTOR'S IGNATURE
SIGNATURE -� ROUGH J SSG
OF PERMITTEE
FINAL .�
ID JACK ALLEN
CK M O.. CASH SUPERVISING M MECHANICAL ENG'R.
i frl;0 5 7 AW 7 4 1 D 1 1.D N r
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE_
WORKER'S COMPENSATION DECLARATION 76AW4 DPW 9/89 ,, APPLICATION, FOR PERMIT
76A384C - _
I,;lereby affirm that I have a certificate of consent to self Insure, LIMFGREEN.•
,ior a certificate of Worker's Compensation Insurance, or a certifiedHEATING `VENTILATING-AIR CONDITIONING
copy thereof(Sec 3800 Lab C
Policy No CompanyAfrt �/! COUNTY OF LOS ANGELES - DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is,hereby furnished "P
❑ gBUILDING
Certified copy is filed with the county building In ection FOR APPLICANT TO FILL IN t ADDRESS
department (PRINT OR TYPE ONLY) _
'Date��` f� �`�Applicant ' LOCALITY , �H NL. ' / a•
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEARE
CERTIFICATE OF,EXEMPTION FROM WORKERS' CROSS ST ®'Q M
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
SO -
(This section need not be completed If the work involved by the MAP BOOK PAGE PARCEL
permit is for one hundred dollaia($100)or-less.)' AIR HANDLING UNIT,CFM
DISTRICT NO ,+ PROCESSED BY - - -
.: I certify that In the performance of the work for which this permit
is Issued, I shall not employ any person in any manner,so as to'' BOILER,BTU
become subject to the Workers'Compensation Laws
COMPRESSOR,BTU
APPROVALS DATE (.• INSPECTOR'S SIGNATURE _
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT If, after•making this Certificate of ROUGH 3
Exemption,you should become subject'to the Workers',Compensatioh EVAPORATIVE COOLER 7'
,-provisions-of the Labor Code, you must•forthwrth comply with such FINAL �Z?Z-�,3
provisions or this permit,shall be deemed revoked - FURNACE . FAU •GRAVITY _
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
-
5
with Section 7000 of Division 3 of the Business and HEATER
'(commencing ) WALL GCrp 2 SOS
Professions Code,and my license is in full force and effect
rise Number f d •, CJ Llc Class 40f4
a
Contractor JZ O �T� Date — _( •0
F] I am exempt under Sec Plan check fee V'
B&P C for this reason PERMIT ISSUING FEE$ 2- 0 9 0
Date TTOTAL FEE JC vS W
Signature PLAN CHECK APPLICANT Cl)
OWNER-BUILDER DECLARATION ''
Z
I hereby affirm that Ilam exempt from the Contractor's License Law NAME
for the-following reason (Section•7031 5, Business and Professions ,5 ;
Code) ADDRESS - a •;- a
❑ I, as owner of the property, or my employees with wages T.
as their sole compensation, will do the work and the• CITY TEL NOf
structure Is not intended or offered for sale (Section 7044, 'r �
Business and Professions Code) OWNER /S J I _TEM,_ __r
❑ 1, as owner of the property,am exclusively COIItracting MAIL T 7
with licensed contractors to construct the project (Sec- ADDRESS " 11`i�� 52'_ Q5,
tion 7044, Business and Professions Code), �O €_HE,-.K c i I 1c
CONSTRUCTION LENDING AGENCY CITY. / ( TEL NO �G O t1 :..e _
I hereby affirm that there Is,a construction lending agency for i (.}•fANGE
the performance of the work for which this permit is Issued CONTRACTOR Q,, '
(Sec 3097, Civ,C) ;' 10
_ ADDRESS y\ F y '
Lender's Name (_ J lliliil-0l01 ,-` f_"t�'
TEL NOS
Lender's Address C `t 7'i +' 9: =
STATE !/ LIC
I certify that I have read this application and state that the above LICENSE NO 7 CLASS ;
Information is correct I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
representatives of this County to enter upon the above-mentioned
prop y for I spectl ,p rposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
54
SI TU F APPLICAN+OR AGENT 11ATE - - '